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Early Identification and Intervention for the Spectrum of Autism

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Early Identification and Intervention for the Spectrum of Autism Early Identification and Intervention for The Spectrum of Autism Developed by the Colorado Autism Task Force - 0 - Why Is Early Identification Important for Children with Autism? “Message number one is that you cannot predict outcome in the pre-school years. Message number two is that appropriate intervention in the pre-school years makes a big difference in the outcome.” -Dr. Isabelle Rapin, The Advocate “Differential and early diagnosis of autism are critical because the prognosis for autistic children has changed markedly since Kanner’s initial work. Identifying and diagnosing autism early can provide access to appropriate services that result in better prognosis. In addition, parents benefit from having a label to put on their child’s problem. It helps them understand why the child is having difficulties and helps to focus treatment efforts.” -B.J. Freeman, The Syndrome of Autism: Update and Guidelines for Diagnosis “…our understanding of these children is growing, and intensive integrated treatment approaches are helping many children make extraordinary developmental progress, the most remarkable of which is their ability to relate to others with warmth, pleasure, empathy, and growing emotional flexibility. The longer such children remain uncommunicative, and the more parents lose their sense of the child’s earlier relatedness, the more deeply the children withdraw, and the more perseverative and idiosyncratic they become.” -M.D. Greenspan, Reconsidering the Diagnosis and Treatment of Very Young Children with Autism Spectrum or Pervasive Development Disorder - 1 - Early Indicators for Screening Sensory-Motor Speech -Language Social Age (restricted repertoire (cognitive (relating to people and (months) of activities) development) objects) · Persistent · No Vocalizing · No anticipatory rocking · Crying not social responses · Inconsistent related to needs (when sees or hears Birth response to stimuli · Does not react mother) (0-06) differentially to · Does not quiet adult voices when held · Poor or absent eye-to-eye contact · Uneven motor · No speech · Foregoing development · Echolalia characteristics · Difficulty with · Pronoun reversal continue by may response to · Abnormal ton become more textures (e.g., and rhythm in interested in social problems speech activities transitioning to · Does not · Does not know table foods) volunteer how to initiate with · Failure to hold information or peers objects or · Upset by changes 06-12 initiate conversation attachment to · May ask in environment unusual objects (or repetitive questions · Delay or absence both) in thematic play · Appears to be deaf · Preoccupation with fingers · Over or under reaction to sensory stimuli (or both) · Loss of · No speech or · Withdrawn previously acquired occasional words · Does not seek skills · Stops talking comfort when · Hyper or hypo- · Gestures don’t distressed sensitivity to develop · May be over stimuli · Repeats sounds distressed by · Seeks repetitive non- separation stimulation 12-24 communicatively · No pretend play · Repetitive · Words used or unusual use of motor mannerisms inconsistently and toys (e.g., spins, appear (e.g., hand may not be related to flicks, lines up flapping, whirling) needs objects) · Imitation does not develop · No interest in peers - 2 - Sensory-Motor Speech -Language Social Age (restricted repertoire (cognitive (relating to people and (months) of activities) development) objects) · Unusual · Mute or · Does not play sensitivity to intermittent talking with others stimuli, and · Echolalia (e.g., · Prefers to be repetitive motor repeats television alone mannerisms commercials) · Does not imitate continue · Specific · Does not show · Hyperactivity or cognitive abilities desire to please hypo activity (or (e.g., good memory, parents both) superior puzzle 24-36 skills) · Appears to be able to do things but refuses · Leads adult by hand to communicate needs · Does not use speech communication · Repetitive · No speech · Foregoing behaviors may · Echolalia characteristics decrease or occur · Pronoun reversal continue by may only intermittently · Abnormal ton become more and rhythm in interested in social speech activities 36-60 · Does not · Does not know volunteer how to initiate with information or peers initiate conversation · Upset by changes · May ask in environment repetitive questions · Delay or absence in thematic play B.J. Freeman, Ph.D. Professor of Medical Psychology Department of Psychiatry and Biobehavioral Sciences UCLA School of Medicine Los Angeles, CA 90024 - 3 - Screening for the Very Young Checklist for Autism in Toddlers – 18 Months Child’s Name Date of Birth Child’s Age Child’s Address Phone Number Section A: Ask Parent 1. Does your child enjoy being swung, bounced on Yes / No your knee, etc.? 2. Does your child take an interest in other Yes / No children? 3. Does your child like climbing on things, such as up stairs? Yes / No 4. Does your child enjoy playing peek-a-boo or Yes / No hide-n-seek? 5. Does your child ever pretend, for example, to make a cup of tea using a toy cup and teapot, or Yes / No pretend other things? 6. Does your child ever use his/her index finger to Yes / No point, to ask for something? 7. Does your child ever use his/her index finger to Yes / No point, to indicate interest in something? 8. Can your child play properly with small toys (e.g., cars or bricks) without just mouthing, Yes / No fiddling, or dropping them? 9. Does your child ever bring obje cts over to you Yes / No (parent) to show you something? - 4 - Section B: Professional Observation/Interaction 10. During the appointment, has the child made eye contact with you? Yes / No 11. Get the child’s attention, then point across the room at an interesting object and say, “Oh look! There’s a (name a toy!” Watch the child’s face. Yes / No Does the child look across to see what you are pointing at? * 12. Get the child’s attention, and then give the child a miniature toy cup, teapot, and say, “Can you make a cup of tea?” Does the child pretend to Yes / No pour out tea, drink it, etc.? ** 13. Say to the child, “Where’s the light?” or “Show me the light”. Does the child point with his/her Yes / No index finger at the light? *** 14. Can the child build a tower of bricks? If so, how Yes / No many? * To record Yes on this item, ensure the child has not simply looked at your hand, but has actually looked at the object you are pointing at. ** If you can elicit an example of pretending in some other game, score Yes on this item. *** Repeat this with “Where’s the teddy?” or some other unreachable object if the child does not understand the word light. To record Yes on this item, the child must have looked up at your face around the time of pointing. Implications: Three or more No responses would indicate a need for further assessment by an Autism specialist (see State criteria). Adapted from Checklist for Autism in Toddlers, Simon Baron- Cohen, Department of experimental Psychology and Psychiatry, University of Cambridge, Downing Street, Cambridge CB2 3EB, U.K. - 5 - The Identification Process Many professionals define Autism and Pervasive Developmental Disorders (PDD) based on a diagnostic manual printed by the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders, or DSM). DSM-IV defines the following specific diagnoses: Autistic Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder. Autism is often referred to as a “spectrum disorder”, meaning the symptoms and characteristics of Autism can present in a wide variety of combinations from mild to severe. Although Autism is defined by a certain set of behaviors, children and adults can exhibit any combination of the behaviors in any degree of severity. Two children, both with a diagnosis of Autism, can act very differently from one another and have individualized program needs. - 6 - Characteristics of Autism Disorder A child identified with Autism will exhibit characteristics und A and B, and one or more characteristics under C through F: A. Social Participation The child displays difficulties, differences, or both interacting with people and events. The child may be unable to establish and maintain reciprocal relationships with people. The child may seek consistency in environmental events to the point of exhibiting rigidity in routines. B. Communication The child displays problems that extend beyond speech and language to other aspects of social communication, both receptively and expressively. The child’s verbal language may be absent or, if present, lacks the usual communicative form, which may involve deviance or delay, or both. The child may have a speech or language disorder or both, in addition to communication difficulties associated with Autism. C. Developmental Rates and Sequences The child exhibits delays, arrests, or regressions in motor, sensory, social, or learning skills. The child may exhibit precocious or advanced skills development, while other skills may develop at normal or extremely depressed rates. The child may not follow developmental patterns in the acquisition of skills. - 7 - D. Cognition The child exhibits abnormalities in the thinking process and in generalizing. The child exhibits strengths in concrete thinking while difficulties are demonstrated in abstract thinking, awareness, and judgment. Perseverant thinking and impaired ability to process symbolic information may be present. E. Sensory Processing The child exhibits unusual, inconsistent, repetitive,
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